title: Umbilical cord blood transplantation from unrelated donors in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia.
abstract: There are very few disease-specific studies focusing on outcomes of umbilical cord blood transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia. We report the outcome of 45 patients with Philadelphia chromosome-positive acute lymphoblastic leukemia who underwent myeloablative single unit cord blood transplantation from unrelated donors within the GETH/GITMO cooperative group. Conditioning regimens were based on combinations of thiotepa, busulfan, cyclophospamide or fludarabine, and antithymocyte globulin. At the time of transplantation, 35 patients (78%) were in first complete remission, four (8%) in second complete remission and six (14%) in third or subsequent response. The cumulative incidence of myeloid engraftment was 96% at a median time of 20 days and significantly better for patients receiving higher doses of CD34(+) cells. The incidence of acute grade II-IV graft-versus-host disease was 31%, while that of overall chronic graft-versus-host disease was 53%. Treatment-related mortality was 17% at day +100 and 31% at 5 years. The 5-year relapse, event-free survival and overall survival rates were 31%, 36% and 44%, respectively. Although the event-free and overall survival rates in patients without BCR/ABL transcripts detectable at time of transplant were better than those in whom BCR/ABL transcripts were detected (46% versus 24% and 60% versus 30%, respectively) these differences were not statistically significant in the univariate analysis (P=0.07). These results demonstrate that umbilical cord blood transplantation from unrelated donors can be a curative treatment for a substantial number of patients with Philadelphia chromosome-positive acute lymphoblastic leukemia.
authors.affiliation: jlpinana@gmail.com.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.forename: Alessandra
authors.initials: A
authors.lastname: Picardi
authors.forename: Christelle
authors.initials: C
authors.lastname: Ferrá
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.forename: Marta
authors.initials: M
authors.lastname: Gonzalez-Vicent
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pascual
authors.forename: Carmen
authors.initials: C
authors.lastname: Martín
authors.forename: Amparo
authors.initials: A
authors.lastname: Verdeguer
authors.forename: Cristina Diaz
authors.initials: CD
authors.lastname: de Heredia
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.forename: José-María
authors.initials: JM
authors.lastname: Ribera
authors.forename: Miguel
authors.initials: M
authors.lastname: Sanz
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning
chemical_list: D019653:Myeloablative Agonists